PART B FEE SCHEDULES

Fee Schedule 93620-94005

CPT/HCPC Code	Modifier	Medicare Location	Global Surgery Indicator	Multiple Surgery Indicator	Prevailing Charge Amount	Fee Schedule Amount	Site of Service Amount
93620		003	0	2	X	3,410.89	X
93620	26	003	0	2	X	2,785.12	X
93620	TC	003	0	2	X	874.26	X
93620		002	0	2	X	3,634.92	X
93620	26	002	0	2	X	2,847.22	X
93620	TC	002	0	2	X	950.18	X
93620		001	0	2	X	3,688.44	X
93620	26	001	0	2	X	2,862.15	X
93620	TC	001	0	2	X	968.22	X
93620		004	0	2	X	3,364.74	X
93620	26	004	0	2	X	2,771.57	X
93620	TC	004	0	2	X	860.52	X
93621	26	002	ZZZ	0	X	2,959.30	X
93621	26	003	ZZZ	0	X	2,793.38	X
93621	26	004	ZZZ	0	X	2,757.84	X
93621	26	001	ZZZ	0	X	2,999.10	X
93622	26	004	ZZZ	0	X	2,742.20	X
93622	26	003	ZZZ	0	X	2,777.50	X
93622	26	002	ZZZ	0	X	2,940.62	X
93622	26	001	ZZZ	0	X	2,979.79	X
93623	26	001	ZZZ	0	X	607.03	X
93623	26	002	ZZZ	0	X	599.49	X
93623	26	003	ZZZ	0	X	567.76	X
93623	26	004	ZZZ	0	X	560.65	X
93624		001	0	2	X	1,045.39	X
93624	26	001	0	2	X	893.56	X
93624	TC	001	0	2	X	215.09	X
93624		004	0	2	X	964.86	X
93624	26	004	0	2	X	870.20	X
93624	TC	004	0	2	X	191.00	X
93624		003	0	2	X	977.02	X
93624	26	003	0	2	X	783.06	X
93624	TC	003	0	2	X	194.00	X
93624		002	0	2	X	1,032.16	X
93624	26	002	0	2	X	889.78	X
93624	TC	002	0	2	X	211.03	X
93631		002	0	0	X	2,147.06	X
93631	26	002	0	0	X	1,452.34	X
93631	TC	002	0	0	X	694.72	X
93631		001	0	0	X	2,182.49	X
93631	26	001	0	0	X	2,877.43	X
93631	TC	001	0	0	X	710.37	X
93631		004	0	0	X	1,974.29	X
93631	26	004	0	0	X	2,833.68	X
93631	TC	004	0	0	X	619.89	X
93631		003	0	0	X	1,999.93	X
93631	26	003	0	0	X	1,370.60	X
93631	TC	003	0	0	X	629.42	X
93640		001	0	2	X	1,451.48	X
93640	26	001	0	2	X	913.09	X
93640	TC	001	0	2	X	776.46	X
93640		004	0	2	X	1,750.67	X
93640	26	004	0	2	X	860.53	X
93640	TC	004	0	2	X	690.10	X
93640		003	0	2	X	1,776.09	X
93640	26	003	0	2	X	1,074.99	X
93640	TC	003	0	2	X	701.15	X
93640		002	0	2	X	1,913.05	X
93640	26	002	0	2	X	904.27	X
93640	TC	002	0	2	X	762.03	X
93641		004	0	2	X	1,988.81	X
93641	26	004	0	2	X	939.14	X
93641		001	0	2	X	1,533.97	X
93641	26	001	0	2	X	995.60	X
93641		003	0	2	X	2,016.85	X
93641	26	003	0	2	X	1,315.75	X
93641		002	0	2	X	2,161.29	X
93641	26	002	0	2	X	986.20	X
93641	TC	001	0	2	X	776.46	X
93641	TC	002	0	2	X	762.03	X
93641	TC	003	0	2	X	701.15	X
93641	TC	004	0	2	X	690.10	X
93642		002	0	2	X	2,085.91	X
93642	26	002	0	2	X	961.36	X
93642	TC	002	0	2	X	762.03	X
93642		003	0	2	X	1,943.79	X
93642	26	003	0	2	X	1,242.69	X
93642	TC	003	0	2	X	701.15	X
93642		004	0	2	X	1,916.49	X
93642	26	004	0	2	X	915.26	X
93642	TC	004	0	2	X	690.10	X
93642		001	0	2	X	1,508.96	X
93642	26	001	0	2	X	970.59	X
93642	TC	001	0	2	X	776.46	X
93644		001	0	2	X	531.98	X
93644	26	001	0	2	X	350.92	X
93644	TC	001	0	2	X	181.07	X
93644		002	0	2	X	473.12	X
93644	26	002	0	2	X	318.49	X
93644	TC	002	0	2	X	154.60	X
93644		003	0	2	X	473.12	X
93644	26	003	0	2	X	318.49	X
93644	TC	003	0	2	X	154.60	X
93644		004	0	2	X	473.12	X
93644	26	004	0	2	X	318.49	X
93644	TC	004	0	2	X	154.60	X
93650		004	0	2	X	2,668.39	X
93650		003	0	2	X	2,703.74	X
93650		002	0	2	X	2,880.86	X
93650		001	0	2	X	2,923.40	X
93653		003	0	2	X	1,336.26	X
93653		004	0	2	X	1,336.26	X
93653		002	0	2	X	1,336.26	X
93653		001	0	2	X	1,486.77	X
93654		001	0	2	X	1,984.13	X
93654		002	0	2	X	1,783.18	X
93654		003	0	2	X	1,783.18	X
93654		004	0	2	X	1,783.18	X
93655		004	ZZZ	0	X	668.08	X
93655		003	ZZZ	0	X	668.08	X
93655		002	ZZZ	0	X	668.08	X
93655		001	ZZZ	0	X	743.23	X
93656		004	0	2	X	1,783.80	X
93656		002	0	2	X	1,783.80	X
93656		003	0	2	X	1,783.80	X
93656		001	0	2	X	1,984.66	X
93657		001	ZZZ	0	X	744.12	X
93657		003	ZZZ	0	X	668.70	X
93657		002	ZZZ	0	X	668.70	X
93657		004	ZZZ	0	X	668.70	X
93660			0	2	X	*	X
93662		002	ZZZ	0	X	684.38	X
93662	26	002	ZZZ	0	X	354.33	X
93662	TC	002	ZZZ	0	X	330.05	X
93662		003	ZZZ	0	X	684.38	X
93662	26	003	ZZZ	0	X	354.33	X
93662	TC	003	ZZZ	0	X	330.05	X
93662		004	ZZZ	0	X	684.38	X
93662	26	004	ZZZ	0	X	354.33	X
93662	TC	004	ZZZ	0	X	330.05	X
93662		001	ZZZ	0	X	785.92	X
93662	26	001	ZZZ	0	X	386.14	X
93662	TC	001	ZZZ	0	X	399.78	X
93668			XXX	0	X	*	X
93701		003	XXX	6	X	74.38	X
93701	26	003	XXX	6	X	19.73	X
93701	TC	003	XXX	6	X	54.68	X
93701		002	XXX	6	X	74.38	X
93701	26	002	XXX	6	X	19.73	X
93701	TC	002	XXX	6	X	54.68	X
93701		001	XXX	6	X	86.36	X
93701	26	001	XXX	6	X	21.64	X
93701	TC	001	XXX	6	X	64.71	X
93701		004	XXX	6	X	74.38	X
93701	26	004	XXX	6	X	19.73	X
93701	TC	004	XXX	6	X	54.68	X
93702		001	XXX	6	X	196.80	X
93702		003	XXX	6	X	168.14	X
93702		004	XXX	6	X	168.14	X
93702		002	XXX	6	X	168.14	X
93724		001	0	6	X	1,258.93	X
93724	26	001	0	6	X	828.81	X
93724	TC	001	0	6	X	430.15	X
93724		004	0	6	X	1,154.36	X
93724	26	004	0	6	X	772.47	X
93724	TC	004	0	6	X	381.89	X
93724		003	0	6	X	1,169.52	X
93724	26	003	0	6	X	781.51	X
93724	TC	003	0	6	X	387.92	X
93724		002	0	6	X	1,241.65	X
93724	26	002	0	6	X	819.64	X
93724	TC	002	0	6	X	422.04	X
93740		003	XXX	9	X	62.11	X
93740	26	003	XXX	9	X	46.95	X
93740	TC	003	XXX	9	X	15.16	X
93740		004	XXX	9	X	61.25	X
93740	26	004	XXX	9	X	46.31	X
93740	TC	004	XXX	9	X	14.92	X
93740		001	XXX	9	X	97.53	X
93740	26	001	XXX	9	X	51.18	X
93740	TC	001	XXX	9	X	46.34	X
93740		002	XXX	9	X	66.73	X
93740	26	002	XXX	9	X	50.37	X
93740	TC	002	XXX	9	X	16.36	X
93745			XXX	0	X	*	X
93750		001	XXX	0	X	97.50	84.88
93750		004	XXX	0	X	89.51	78.85
93750		003	XXX	0	X	89.51	78.85
93750		002	XXX	0	X	89.51	78.85
93770		001	XXX	9	X	39.52	X
93770	26	001	XXX	9	X	36.46	X
93770	TC	001	XXX	9	X	3.01	X
93770		004	XXX	9	X	36.08	X
93770	26	004	XXX	9	X	33.34	X
93770	TC	004	XXX	9	X	2.82	X
93770		002	XXX	9	X	58.06	X
93770	26	002	XXX	9	X	91.77	X
93770	TC	002	XXX	9	X	3.00	X
93770		003	XXX	9	X	53.75	X
93770	26	003	XXX	9	X	90.88	X
93770	TC	003	XXX	9	X	2.83	X
93784			XXX	6	X	*	X
93786			XXX	6	X	*	X
93788			XXX	6	X	*	X
93790			XXX	0	X	*	X
93792		004	XXX	0	X	75.41	X
93792		003	XXX	0	X	75.41	X
93792		002	XXX	0	X	75.41	X
93792		001	XXX	0	X	86.73	X
93793		001	XXX	0	X	18.88	X
93793		002	XXX	0	X	17.40	X
93793		003	XXX	0	X	17.40	X
93793		004	XXX	0	X	17.40	X
93797		002	0	0	X	59.23	41.90
93797		004	0	0	X	47.32	33.37
93797		003	0	0	X	51.65	36.44
93797		001	0	0	X	59.98	42.31
93798		004	0	0	X	75.72	53.46
93798		002	0	0	X	83.24	58.67
93798		001	0	0	X	84.39	59.59
93798		003	0	0	X	78.90	55.67
93799			XXX	0	X	#	X
93880		004	XXX	6	X	628.05	X
93880	26	004	XXX	6	X	266.92	X
93880	TC	004	XXX	6	X	350.02	X
93880		003	XXX	6	X	642.73	X
93880	26	003	XXX	6	X	285.29	X
93880	TC	003	XXX	6	X	355.41	X
93880		002	XXX	6	X	657.91	X
93880	26	002	XXX	6	X	282.11	X
93880	TC	002	XXX	6	X	391.44	X
93880		001	XXX	6	X	660.57	X
93880	26	001	XXX	6	X	287.59	X
93880	TC	001	XXX	6	X	400.06	X
93882		003	XXX	6	X	619.88	X
93882	26	003	XXX	6	X	262.44	X
93882	TC	003	XXX	6	X	355.41	X
93882		002	XXX	6	X	633.83	X
93882	26	002	XXX	6	X	257.99	X
93882	TC	002	XXX	6	X	391.44	X
93882		001	XXX	6	X	636.18	X
93882	26	001	XXX	6	X	263.23	X
93882	TC	001	XXX	6	X	400.06	X
93882		004	XXX	6	X	605.46	X
93882	26	004	XXX	6	X	244.37	X
93882	TC	004	XXX	6	X	350.02	X
93886		002	XXX	6	X	564.53	X
93886	26	002	XXX	6	X	173.08	X
93886	TC	002	XXX	6	X	391.44	X
93886		003	XXX	6	X	518.68	X
93886	26	003	XXX	6	X	163.34	X
93886	TC	003	XXX	6	X	355.41	X
93886		004	XXX	6	X	511.44	X
93886	26	004	XXX	6	X	161.42	X
93886	TC	004	XXX	6	X	350.02	X
93886		001	XXX	6	X	575.46	X
93886	26	001	XXX	6	X	175.39	X
93886	TC	001	XXX	6	X	400.06	X
93888		004	XXX	6	X	459.38	X
93888	26	004	XXX	6	X	109.40	X
93888	TC	004	XXX	6	X	350.02	X
93888		003	XXX	6	X	466.01	X
93888	26	003	XXX	6	X	110.62	X
93888	TC	003	XXX	6	X	355.41	X
93888		002	XXX	6	X	507.62	X
93888	26	002	XXX	6	X	116.17	X
93888	TC	002	XXX	6	X	391.44	X
93888		001	XXX	6	X	517.63	X
93888	26	001	XXX	6	X	117.57	X
93888	TC	001	XXX	6	X	400.06	X
93890		001	XXX	6	X	556.72	X
93890	26	001	XXX	6	X	122.22	X
93890	TC	001	XXX	6	X	434.48	X
93890		004	XXX	6	X	463.76	X
93890	26	004	XXX	6	X	112.11	X
93890	TC	004	XXX	6	X	351.62	X
93890		002	XXX	6	X	463.76	X
93890	26	002	XXX	6	X	112.11	X
93890	TC	002	XXX	6	X	351.62	X
93890		003	XXX	6	X	463.76	X
93890	26	003	XXX	6	X	112.11	X
93890	TC	003	XXX	6	X	351.62	X
93892		004	XXX	6	X	494.51	X
93892	26	004	XXX	6	X	128.38	X
93892	TC	004	XXX	6	X	366.12	X
93892		003	XXX	6	X	494.51	X
93892	26	003	XXX	6	X	128.38	X
93892	TC	003	XXX	6	X	366.12	X
93892		002	XXX	6	X	494.51	X
93892	26	002	XXX	6	X	128.38	X
93892	TC	002	XXX	6	X	366.12	X
93892		001	XXX	6	X	591.46	X
93892	26	001	XXX	6	X	139.60	X
93892	TC	001	XXX	6	X	451.88	X
93893		001	XXX	6	X	580.11	X
93893	26	001	XXX	6	X	139.60	X
93893	TC	001	XXX	6	X	440.55	X
93893		003	XXX	6	X	485.06	X
93893	26	003	XXX	6	X	128.38	X
93893	TC	003	XXX	6	X	356.71	X
93893		004	XXX	6	X	485.06	X
93893	26	004	XXX	6	X	128.38	X
93893	TC	004	XXX	6	X	356.71	X
93893		002	XXX	6	X	485.06	X
93893	26	002	XXX	6	X	128.38	X
93893	TC	002	XXX	6	X	356.71	X
93895			XXX	6	X	*	X
93922		001	XXX	6	X	363.86	X
93922	26	001	XXX	6	X	196.07	X
93922	TC	001	XXX	6	X	240.34	X
93922		002	XXX	6	X	381.32	X
93922	26	002	XXX	6	X	176.48	X
93922	TC	002	XXX	6	X	233.91	X
93922		004	XXX	6	X	333.99	X
93922	26	004	XXX	6	X	182.95	X
93922	TC	004	XXX	6	X	116.72	X
93922		003	XXX	6	X	390.19	X
93922	26	003	XXX	6	X	194.17	X
93922	TC	003	XXX	6	X	118.50	X
93923		001	XXX	6	X	421.43	X
93923	26	001	XXX	6	X	214.47	X
93923	TC	001	XXX	6	X	279.53	X
93923		003	XXX	6	X	441.69	X
93923	26	003	XXX	6	X	211.00	X
93923	TC	003	XXX	6	X	223.77	X
93923		002	XXX	6	X	437.78	X
93923	26	002	XXX	6	X	194.58	X
93923	TC	002	XXX	6	X	272.23	X
93923		004	XXX	6	X	384.79	X
93923	26	004	XXX	6	X	199.50	X
93923	TC	004	XXX	6	X	220.40	X
93924		001	XXX	6	X	422.09	X
93924	26	001	XXX	6	X	208.97	X
93924	TC	001	XXX	6	X	276.74	X
93924		002	XXX	6	X	446.08	X
93924	26	002	XXX	6	X	203.41	X
93924	TC	002	XXX	6	X	270.55	X
93924		003	XXX	6	X	447.45	X
93924	26	003	XXX	6	X	211.84	X
93924	TC	003	XXX	6	X	244.62	X
93924		004	XXX	6	X	401.36	X
93924	26	004	XXX	6	X	188.96	X
93924	TC	004	XXX	6	X	240.92	X
93925		001	XXX	6	X	516.12	X
93925	26	001	XXX	6	X	116.11	X
93925	TC	001	XXX	6	X	400.06	X
93925		004	XXX	6	X	456.97	X
93925	26	004	XXX	6	X	106.91	X
93925	TC	004	XXX	6	X	350.02	X
93925		003	XXX	6	X	463.68	X
93925	26	003	XXX	6	X	108.25	X
93925	TC	003	XXX	6	X	355.41	X
93925		002	XXX	6	X	505.99	X
93925	26	002	XXX	6	X	114.57	X
93925	TC	002	XXX	6	X	391.44	X
93926		004	XXX	6	X	403.47	X
93926	26	004	XXX	6	X	53.47	X
93926	TC	004	XXX	6	X	350.02	X
93926		002	XXX	6	X	448.88	X
93926	26	002	XXX	6	X	57.50	X
93926	TC	002	XXX	6	X	391.44	X
93926		003	XXX	6	X	409.50	X
93926	26	003	XXX	6	X	54.15	X
93926	TC	003	XXX	6	X	355.41	X
93926		001	XXX	6	X	458.36	X
93926	26	001	XXX	6	X	58.28	X
93926	TC	001	XXX	6	X	400.06	X
93930		001	XXX	6	X	496.39	X
93930	26	001	XXX	6	X	96.36	X
93930	TC	001	XXX	6	X	400.06	X
93930		004	XXX	6	X	438.82	X
93930	26	004	XXX	6	X	88.92	X
93930	TC	004	XXX	6	X	350.02	X
93930		003	XXX	6	X	445.30	X
93930	26	003	XXX	6	X	89.95	X
93930	TC	003	XXX	6	X	355.41	X
93930		002	XXX	6	X	486.47	X
93930	26	002	XXX	6	X	95.04	X
93930	TC	002	XXX	6	X	391.44	X
93931		002	XXX	6	X	438.44	X
93931	26	002	XXX	6	X	47.05	X
93931	TC	002	XXX	6	X	391.44	X
93931		001	XXX	6	X	447.75	X
93931	26	001	XXX	6	X	47.63	X
93931	TC	001	XXX	6	X	400.06	X
93931		004	XXX	6	X	393.87	X
93931	26	004	XXX	6	X	43.92	X
93931	TC	004	XXX	6	X	350.02	X
93931		003	XXX	6	X	399.80	X
93931	26	003	XXX	6	X	44.46	X
93931	TC	003	XXX	6	X	355.41	X
93970		004	XXX	6	X	476.06	X
93970	26	004	XXX	6	X	126.06	X
93970	TC	004	XXX	6	X	350.02	X
93970		003	XXX	6	X	482.93	X
93970	26	003	XXX	6	X	127.60	X
93970	TC	003	XXX	6	X	355.41	X
93970		002	XXX	6	X	526.91	X
93970	26	002	XXX	6	X	135.44	X
93970	TC	002	XXX	6	X	391.44	X
93970		001	XXX	6	X	537.46	X
93970	26	001	XXX	6	X	137.42	X
93970	TC	001	XXX	6	X	400.06	X
93971		002	XXX	6	X	458.92	X
93971	26	002	XXX	6	X	67.55	X
93971	TC	002	XXX	6	X	391.44	X
93971		003	XXX	6	X	419.16	X
93971	26	003	XXX	6	X	63.85	X
93971	TC	003	XXX	6	X	355.41	X
93971		004	XXX	6	X	413.06	X
93971	26	004	XXX	6	X	63.04	X
93971	TC	004	XXX	6	X	350.02	X
93971		001	XXX	6	X	468.44	X
93971	26	001	XXX	6	X	68.40	X
93971	TC	001	XXX	6	X	400.06	X
93975		002	XXX	6	X	671.50	X
93975	26	002	XXX	6	X	280.09	X
93975	TC	002	XXX	6	X	391.44	X
93975		001	XXX	6	X	683.29	X
93975	26	001	XXX	6	X	283.30	X
93975	TC	001	XXX	6	X	400.06	X
93975		004	XXX	6	X	614.17	X
93975	26	004	XXX	6	X	264.19	X
93975	TC	004	XXX	6	X	350.02	X
93975		003	XXX	6	X	622.52	X
93975	26	003	XXX	6	X	267.16	X
93975	TC	003	XXX	6	X	355.41	X
93976		002	XXX	6	X	531.74	X
93976	26	002	XXX	6	X	140.30	X
93976	TC	002	XXX	6	X	391.44	X
93976		001	XXX	6	X	541.94	X
93976	26	001	XXX	6	X	141.87	X
93976	TC	001	XXX	6	X	400.06	X
93976		004	XXX	6	X	482.63	X
93976	26	004	XXX	6	X	132.61	X
93976	TC	004	XXX	6	X	350.02	X
93976		003	XXX	6	X	489.47	X
93976	26	003	XXX	6	X	134.09	X
93976	TC	003	XXX	6	X	355.41	X
93978		002	XXX	6	X	519.51	X
93978	26	002	XXX	6	X	128.02	X
93978	TC	002	XXX	6	X	391.44	X
93978		001	XXX	6	X	529.83	X
93978	26	001	XXX	6	X	129.80	X
93978	TC	001	XXX	6	X	400.06	X
93978		004	XXX	6	X	469.35	X
93978	26	004	XXX	6	X	119.41	X
93978	TC	004	XXX	6	X	350.02	X
93978		003	XXX	6	X	476.21	X
93978	26	003	XXX	6	X	120.81	X
93978	TC	003	XXX	6	X	355.41	X
93979		001	XXX	6	X	466.47	X
93979	26	001	XXX	6	X	66.40	X
93979	TC	001	XXX	6	X	400.06	X
93979		002	XXX	6	X	456.97	X
93979	26	002	XXX	6	X	65.51	X
93979	TC	002	XXX	6	X	391.44	X
93979		003	XXX	6	X	417.22	X
93979	26	003	XXX	6	X	61.87	X
93979	TC	003	XXX	6	X	355.41	X
93979		004	XXX	6	X	411.14	X
93979	26	004	XXX	6	X	61.10	X
93979	TC	004	XXX	6	X	350.02	X
93980		001	XXX	6	X	681.25	X
93980	26	001	XXX	6	X	281.12	X
93980	TC	001	XXX	6	X	400.06	X
93980		004	XXX	6	X	613.03	X
93980	26	004	XXX	6	X	263.01	X
93980	TC	004	XXX	6	X	350.02	X
93980		003	XXX	6	X	621.31	X
93980	26	003	XXX	6	X	265.98	X
93980	TC	003	XXX	6	X	355.41	X
93980		002	XXX	6	X	669.65	X
93980	26	002	XXX	6	X	278.17	X
93980	TC	002	XXX	6	X	391.44	X
93981		001	XXX	6	X	480.56	X
93981	26	001	XXX	6	X	110.92	X
93981	TC	001	XXX	6	X	369.68	X
93981		004	XXX	6	X	426.28	X
93981	26	004	XXX	6	X	103.33	X
93981	TC	004	XXX	6	X	322.96	X
93981		003	XXX	6	X	432.44	X
93981	26	003	XXX	6	X	104.55	X
93981	TC	003	XXX	6	X	327.91	X
93981		002	XXX	6	X	471.29	X
93981	26	002	XXX	6	X	109.73	X
93981	TC	002	XXX	6	X	361.62	X
93985		003	XXX	6	X	355.08	X
93985	26	003	XXX	6	X	53.86	X
93985	TC	003	XXX	6	X	301.19	X
93985		004	XXX	6	X	355.08	X
93985	26	004	XXX	6	X	53.86	X
93985	TC	004	XXX	6	X	301.19	X
93985		001	XXX	6	X	405.12	X
93985	26	001	XXX	6	X	58.00	X
93985	TC	001	XXX	6	X	347.13	X
93985		002	XXX	6	X	355.08	X
93985	26	002	XXX	6	X	53.86	X
93985	TC	002	XXX	6	X	301.19	X
93986		002	XXX	6	X	180.44	X
93986	26	002	XXX	6	X	34.75	X
93986	TC	002	XXX	6	X	145.68	X
93986		004	XXX	6	X	180.44	X
93986	26	004	XXX	6	X	34.75	X
93986	TC	004	XXX	6	X	145.68	X
93986		003	XXX	6	X	180.44	X
93986	26	003	XXX	6	X	34.75	X
93986	TC	003	XXX	6	X	145.68	X
93986		001	XXX	6	X	205.65	X
93986	26	001	XXX	6	X	37.72	X
93986	TC	001	XXX	6	X	167.95	X
93990		002	XXX	6	X	438.44	X
93990	26	002	XXX	6	X	47.05	X
93990	TC	002	XXX	6	X	391.44	X
93990		003	XXX	6	X	399.80	X
93990	26	003	XXX	6	X	44.46	X
93990	TC	003	XXX	6	X	355.41	X
93990		004	XXX	6	X	393.87	X
93990	26	004	XXX	6	X	43.92	X
93990	TC	004	XXX	6	X	350.02	X
93990		001	XXX	6	X	447.75	X
93990	26	001	XXX	6	X	47.63	X
93990	TC	001	XXX	6	X	400.06	X
93998			XXX	0	X	#	X
94002		001	XXX	0	X	160.20	X
94002		002	XXX	0	X	148.99	X
94002		003	XXX	0	X	148.99	X
94002		004	XXX	0	X	148.99	X
94003		002	XXX	0	X	108.27	X
94003		003	XXX	0	X	108.27	X
94003		004	XXX	0	X	108.27	X
94003		001	XXX	0	X	117.29	X
94004		001	XXX	0	X	85.35	X
94004		002	XXX	0	X	78.94	X
94004		003	XXX	0	X	78.94	X
94004		004	XXX	0	X	78.94	X
94005			XXX	9	X	*	X

Fee Schedule 93620-94005

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